Behavioral Health Care in Michigan

Michigan’s Unmet Need for Behavioral Healthcare

Behavioral health disorders are highly prevalent throughout Michigan. According to the Cover Michigan Survey in 2012, 26% of Michiganders have been diagnosed with depression or anxiety (20% with depression and 18% with anxiety); 59% of Michiganders with Medicaid have been diagnosed with depression or anxiety1. Additionally, behavioral health disorders are often comorbid with chronic physical pain, diabetes, heart disease, and cancer. These disorders are costly, both in terms of care and individual productivity1.

 

Access to high-quality, affordable behavioral health care is a significant challenge for Michigan residents1. Low-income adults and seniors who are treated in community health centers (CHCs) face significant barriers, including insurance limitations and unaffordable costs2. Additionally, the majority of Michigan primary care providers report difficulty accessing behavioral health care for their patients; this is supported by data indicating a short supply of psychiatric providers, particularly those who accept public health insurance3,4. As a result, seniors and low-income adults often depend solely upon their primary care providers for behavioral health care. Unfortunately, primary care providers must address a myriad of medical conditions during a short visit and their expertise in treating behavioral health conditions may be limited.

 

Integrated Care

Integrating primary care and behavioral health services is a valuable solution to address the shortage of psychiatric providers and improve behavioral health outcomes in primary care. Traditionally, primary care, behavioral health care, and other social services have been separate. Integrated care unites these services under one roof, improving access to care and coordination of services. The majority of Michigan’s CHCs have integrated behavioral health and primary care services. While this is a positive step, integration has created an influx of patients with behavioral health needs. Many of these patients require care and monitoring beyond what a PCP or a traditional primary-care based behavioral health provider (e.g., LMSW, RN, LPC) can offer. As a result, many CHCs report a backlog of patients waiting for psychiatry services, with providers managing patients the best they can.

 

A Solution to Michigan’s Critical Need for Improved Access to Behavioral Healthcare

Collaborative Care (CoCM) is one model of integrated behavioral health care that both leverages limited psychiatric time and has the strongest evidence-base for improving behavioral health outcomes in primary care.

 

This model was originally developed to treat depression in seniors but has since been proven to be effective for other common and persistent behavioral health conditions in both adult and youth populations. CoCM incorporates a psychiatric consultant and behavioral health care manager into the care team and uses a patient registry to maintain a proactive population health approach to caring for patients in primary care. Compared to usual care, this model uniquely leverages scarce psychiatric resources while achieving and sustaining improved behavioral health outcomes.

With the goal of enhancing behavioral health care for Michigan residents, MCCIST works to implement this model in community health centers across the state, improving their capacity to provide affordable, timely, and high-quality behavioral health care.

Click here to learn more about the Collaborative Care Model.

 

References

  1. Smiley, M., Young, D., Udow- Phillips, M., Riba, M., Traylor, J. (2013). Access to Mental Health Care in Michigan. Cover Michigan Survey 2013. Ann Arbor, MI. Retrieved from http://www.chrt.org/assets/cover-michigan-survey-2013/CHRT-Cover-Michigan-Survey-2013-Report-3-Mental-Health-Care.pdf
  2. Baum, N., & Bondalapati, K. (2016). Washtenaw County Mental Health and Substance Use Service Gaps Assessment Mental Health and Substance Use Work Group. Ann Arbor, MI.
  3. Michigan Department of Community Health 2012 Survey of Physicians. (2013). Public Sector Consultants, Inc. Retrieved from https://www.michigan.gov/documents/healthcareworkforcecenter/Survey_of_Physicians_Final_Report_2012_418612_7.pdf
  4. Thomas, K. C., Ellis, A. R., Konrad, T. R., Holzer, C. E., & Morrissey, J. P. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services, 60(10), 1323–1328. https://doi.org/10.1176/appi.ps.60.10.1323